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PATHOS: A Brief Screening Application for Assessing Sexual Addiction

Carnes, Patrick J. PhD; Green, Bradley A. PhD; Merlo, Lisa J. PhD, MPE; Polles, Alexis MD; Carnes, Stefanie PhD; Gold, Mark S. MD

Journal of Addiction Medicine:
doi: 10.1097/ADM.0b013e3182251a28
Original Research

Sexual addiction is estimated to afflict up to 3% to 6% of the population. However, many clinicians lack clear criteria for detecting potential cases.

Objectives: The present studies were conducted to assess the effectiveness of a brief sexual addiction screening instrument (ie, PATHOS Questionnaire) to correctly classify patients being treated for sex addiction and healthy volunteers.

Methods: In study 1, a 6-item questionnaire, which utilizes the mnemonic “PATHOS,” was examined in regard to sensitivity and specificity using a sample combining patients being treated for sex addiction and healthy volunteers (970 men/80.2% patients; 938 women/63.8% patients). In study 2, a cross-validation sample of 672 men (93% patients) and 241 women (35.3% patients) completed the PATHOS screener.

Results: Results of receiver operating characteristics analyses in study 1 demonstrated that the PATHOS captured 92.6% of the area under the curve and achieved 88.3% sensitivity and 81.6% specificity for classifying the male sample (n = 963) as patients and healthy subjects using a cutoff score of 3. Similarly, the PATHOS captured 90.2% of the area under the curve and, with a cutoff of 3, achieved 80.9% sensitivity and 87.2% specificity for the female sample (n = 808). In study 2, results of receiver operating characteristics analyses indicated that the PATHOS captured 85.1% of the area under the curve, with sensitivity of 70.7% and specificity of 86.9% for men (cutoff of 3). For women, the PATHOS captured 80.9% of the area under the curve and achieved 69.7% sensitivity and 85.1% specificity with the cutoff of 3.

Conclusions: These studies provide support for the use of the PATHOS as a screening instrument to detect potential sexual addiction cases in clinical settings.

Author Information

From the Pine Grove Behavioral Health Services (PJC) and Department of Psychology, University of Southern Mississippi (BAG), Hattiesburg, MS; Department of Psychiatry, University of Florida, Gainesville, FL (LJM, MSG); Washington University, Department of Psychiatry, St Louis, MO (LJM); COPAC Addiction Treatment Services, Brandon, MS (AP); and IITAP, LLC, Carefree, AZ (SC).

Send correspondence and reprint requests to Stefanie Carnes, PhD, IITAP, LLC, PO Box 2112, Carefree, AZ 85377. E-mail:

No conflicts of interest to report.

The third author was supported in part by National Institute on Drug Abuse (NIDA) training grant T32-DA-07313-10 (PI: Linda B. Cottler). NIDA had no further role in study design; in the collection, analysis, and interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication.

Received July 20, 2010

Accepted May 18, 2011

© 2012 American Society of Addiction Medicine